Effectiveness of a Two-Step Testing Algorithm for Reliable and Cost-Effective Detection of Clostridium difficile Infection in a Tertiary Care Hospital in Saudi Arabia

The aim of this study was to evaluate the effectiveness of a two-step algorithm for the detection of Clostridium difficile infection. Setting and Design: A two-step testing algorithm was evaluated for testing stool samples from patients suspected of Clostridium difficile infection (CDI). A total of 103 stool specimens were tested using the C. diff Quik Chek Complete enzyme immunoassay (EIA) test and the Xpert C. difficile PCR test. A two-step algorithm was implemented, and data from 3518 patient samples tested during a two-year period after implementation were analyzed to evaluate the effectiveness. The sensitivity, specificity, and positive and negative predictive values (PPV, NPV) of the Quik Chek Complete EIA test were calculated using the Xpert C. difficile PCR test as a reference method. The sensitivity, specificity, PPV, and NPV of the Quik Chek Complete EIA test for C. difficile toxin were 46.7%, 100%, 100%, and 91%, respectively. The two-step algorithm, which combined the Quik Chek Complete EIA with Xpert C. difficile PCR, improved the sensitivity and also provided rapid detection. When algorithm-based testing was performed daily, there was a 66% reduction in turnaround time compared to batch testing using a lengthy ELISA procedure. Postimplementation data analysis showed that almost 89% of the samples could be reported immediately by initial screening with Quik Chek Complete EIA. Only 11% of the samples gave discrepant results and required PCR confirmation. According to our results, the two-step algorithm is an effective tool for the rapid and reliable detection of toxigenic C. difficile from stool samples.

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Searching for a Potential Algorithm for Clostridium difficile Testing at a Tertiary Care Hospital: Does Toxin Enzyme Immunoassay Testing Help?

Journal of Clinical Microbiology ◽

10.1128/jcm.00415-18 ◽

2018 ◽

Vol 56 (7) ◽

pp. e00415-18

Author(s):

Angela M. Theiss ◽

Agnes Balla ◽

Angie Ross ◽

Denise Francis ◽

Christina Wojewoda

Keyword(s):

Clostridium Difficile ◽

Clinical Management ◽

Tertiary Care ◽

Laboratory Data ◽

The United States ◽

Care Hospital ◽

Content Type ◽

Molecular Tests ◽

Stool Samples ◽

Testing Algorithm

ABSTRACT Clostridium difficile is a major contributor to morbidity and mortality in the United States. Methods for identifying the organism in stool include molecular platforms, enzyme immunoassays (EIAs) for toxin, and culture. Controversy persists over whether molecular tests are too sensitive at identifying C. difficile, and there are questions about how additional laboratory information could inform clinical management and reduce over treatment. The aim of this study was to assess whether clinical factors are related to the toxin status of patients and whether information about toxin status could potentially inform clinical management of patients. A total of 201 PCR-positive C. difficile stool samples from adult patients at our institution underwent EIA toxin testing. Clinical and laboratory data were collected, and the percentage of PCR-positive/EIA-positive (PCR+/EIA+) patients and PCR+ and EIA-negative (PCR+/EIA−) patients was calculated. Of the 201 samples, 47% were EIA positive and 53% were EIA negative. Although PCR+/EIA+ patients were more likely to have had a prior C. difficile infection (P = 0.015), there was no statistical difference between the additional data collected that correlated with a positive EIA result. We were unable to show that patients with an EIA+ result had worse clinical parameters than those with EIA− results and concluded that establishing a testing algorithm that included both PCR and EIA testing would not change the clinical management of patients at our hospital.

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Evaluation of HiCrome KPC Agar for the Screening of Carbapenem-Resistant Enterobacterales Colonization in the ICU Setting of a Tertiary Care Hospital

Journal of Laboratory Physicians ◽

10.1055/s-0041-1732494 ◽

2021 ◽

Author(s):

Ashoka Mahapatra ◽

K Nikitha ◽

Sutapa Rath ◽

Bijayini Behera ◽

Kavita Gupta

Keyword(s):

Tertiary Care ◽

High Sensitivity ◽

Care Hospital ◽

Predictive Values ◽

Klebsiella Pneumoniae Carbapenemase ◽

Carbapenem Resistant ◽

Rectal Swabs ◽

Control And Prevention ◽

Indian Setting ◽

Sensitivity Specificity

Abstract Background Spread of carbapenem-resistant Enterobacterales (CRE) is a significant concern in intensive care unit (ICU) settings. Approaches to routine screening for CRE colonization in all ICU patients vary depending on institutional epidemiology and resources. The present study was aimed to evaluate the performance of HiCrome Klebsiella pneumoniae carbapenemase (KPC) agar for the detection of CRE colonization in ICU settings taking the Centers for Disease Control and Prevention (CDC) recommended method as reference. Methods Two-hundred and eighty rectal swabs (duplicate) from 140 patients were subjected to CRE detection in HiCrome KPC agar and MacConkey agar (CDC criteria). Results Using CDC method, total 41 CRE isolates were recovered comprising of 29 E scherichia coli, 11 Klebsiella, and 1 Enterobacter spp. On the other hand, 49 isolates of CRE recovered from 140 rectal swabs using HiCrome KPC agar, out of which 33 were E. coli, 15 Klebsiella, and 1 Enterobacter sp. Statistical Analysis Sensitivity, specificity, negative, and positive predictive values of CRE screening by HiCrome KPC agar were found to be 100% (91.4–100), 91.9% (84.8–95.8), 83.6% (70.9–91.4), and 100% (95.9–100), respectively, taking the CDC recommended method as reference. Conclusion HiCrome KPC agar has high sensitivity in screening CRE colonization. Further studies are needed to establish its applicability for detecting the predominant circulating carbapenemases in the Indian setting.

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Epidemiology of Clostridium difficile infection in Portugal: Experience at a tertiary care hospital

European Journal of Internal Medicine ◽

10.1016/j.ejim.2018.10.009 ◽

2019 ◽

Vol 60 ◽

pp. e11-e13 ◽

Cited By ~ 1

Author(s):

Sara Sintra ◽

Filipe Taveira ◽

Catarina Canha ◽

Armando Carvalho ◽

Adélia Simão

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital

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Clinical and demographic profile of patients reporting for Clostridium difficile infection in a tertiary care hospital

Indian Journal of Medical Microbiology ◽

10.4103/0255-0857.153570 ◽

2015 ◽

Vol 33 (2) ◽

pp. 326 ◽

Cited By ~ 7

Author(s):

C Vaishnavi ◽

M Singh ◽

P Kapoor ◽

R Kochhar

Keyword(s):

Clostridium Difficile ◽

Clostridium Difficile Infection ◽

Tertiary Care Hospital ◽

Tertiary Care ◽

Care Hospital ◽

Demographic Profile

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Clostridium difficile colonization among patients with clinically significant diarrhea and no identifiable cause of diarrhea

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.225 ◽

2018 ◽

Vol 39 (11) ◽

pp. 1330-1333 ◽

Cited By ~ 4

Author(s):

Erik R. Dubberke ◽

Kimberly A. Reske ◽

Tiffany Hink ◽

Jennie H. Kwon ◽

Candice Cass ◽

...

Keyword(s):

Clostridium Difficile ◽

Patient Population ◽

Tertiary Care ◽

Clinical Microbiology Laboratory ◽

Care Hospital ◽

Toxigenic Culture ◽

Stool Samples ◽

Stool Specimens ◽

Clinically Significant ◽

Culture Negative

AbstractObjectiveTo determine the prevalence of Clostridium difficile colonization among patients who meet the 2017 IDSA/SHEA C. difficile infection (CDI) Clinical Guideline Update criteria for the preferred patient population for C. difficile testing.DesignRetrospective cohort.SettingTertiary-care hospital in St. Louis, Missouri.PatientsPatients whose diarrheal stool samples were submitted to the hospital’s clinical microbiology laboratory for C. difficile testing (toxin EIA) from August 2014 to September 2016.InterventionsElectronic and manual chart review were used to determine whether patients tested for C. difficile toxin had clinically significant diarrhea and/or any alternate cause for diarrhea. Toxigenic C. difficile culture was performed on all stool specimens from patients with clinically significant diarrhea and no known alternate cause for their diarrhea.ResultsA total of 8,931 patients with stool specimens submitted were evaluated: 570 stool specimens were EIA positive (+) and 8,361 stool specimens were EIA negative (−). Among the EIA+stool specimens, 107 (19% of total) were deemed eligible for culture. Among the EIA− stool specimens, 515 (6%) were eligible for culture. One EIA+stool specimen (1%) was toxigenic culture negative. Among the EIA− stool specimens that underwent culture, toxigenic C. difficile was isolated from 63 (12%).ConclusionsMost patients tested for C. difficile do not have clinically significant diarrhea and/or potential alternate causes for diarrhea. The prevalence of toxigenic C. difficile colonization among EIA− patients who met the IDSA/SHEA CDI guideline criteria for preferred patient population for C. difficile testing was 12%.

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